Individual hemiendoprosthetics of the posterior articular facet of the calcaneus in the complex treatment of damage to the subtalar joint: a case report

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BACKGROUND: The subtalar joint is one of the key joints in the foot. Its main function is to adapt the hindfoot to uneven ground during the gait cycle. Degenerative changes in the subtalar joint are primarily the result of intra-articular calcaneal fractures, varus or valgus deformities of the hindfoot, rheumatoid arthritis and idiopathic deforming osteoarthritis. Arthrodesis of the subtalar joint results in restriction of supination-pronation movements of the foot, overloading of the external compartments and, as a consequence, impaired gait biomechanics.

DESCRIPTION OF THE CASE: We present a clinical case of surgical treatment of a patient with a malunited fracture of the calcaneus. The posterior articular facet of the calcaneus was hemiendoprosthetically replaced with a custom-made ceramic implant.

CONCLUSION: Short-term results of the patient's treatment with posttraumatic deforming arthrosis of the subtalar joint allow us to conclude on the efficacy of the posterior articular facet hemiendoprosthesis of the calcaneus in the treatment of this pathology. The proposed technique makes it possible to preserve the mobility of the hindfoot and reduce the severity of the pain syndrome.

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作者简介

Vladimir Skrebtsov

Yudin City Clinical Hospital

编辑信件的主要联系方式.
Email: Skrebtsov@mail.ru
ORCID iD: 0000-0003-0833-6628
SPIN 代码: 6002-7102

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 4 Kolomenskiy passage, 115446 Moscow

Viktor Protsko

Yudin City Clinical Hospital; Russian Peoples’ Friendship University

Email: 89035586679@mail.ru
ORCID iD: 0000-0002-5077-2186
SPIN 代码: 4628-7919

MD, Dr. Sci. (Medicine), professor

俄罗斯联邦, 4 Kolomenskiy passage, 115446 Moscow; Moscow

Alexander Skrebtsov

Yudin City Clinical Hospital

Email: Skrebtsovalex@mail.ru
ORCID iD: 0000-0002-1418-3368
SPIN 代码: 3682-4569

MD

俄罗斯联邦, 4 Kolomenskiy passage, 115446 Moscow

Sargon Tamoev

Yudin City Clinical Hospital

Email: Sargonik@mail.ru
ORCID iD: 0000-0001-8748-0059
SPIN 代码: 2986-1390

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 4 Kolomenskiy passage, 115446 Moscow

Vasilii Kuznetsov

Yudin City Clinical Hospital

Email: vkuznecovniito@gmail.com
ORCID iD: 0000-0001-6287-8132
SPIN 代码: 6499-2760

MD, Cand. Sci. (Medicine);

俄罗斯联邦, 4 Kolomenskiy passage, 115446 Moscow

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2. Fig. 1. Appearance of the feet: a — rear view, b — side view. Flattening of the internal longitudinal arch and valgus deviation of the heel bone of the right foot are determined.

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3. Fig. 2. MSCT scans of the right ankle joint and foot: a — coronary projection, b — sagittal projection. Narrowing and unevenness of the joint space, osteochondral exostosis of the subtalar joint area are noted.

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4. Fig. 3. Dynamic pedobarography graph in the preoperative period: a — left foot, b — right foot. There is an increase in the duration of the heel strike and loading phase, a decrease in the strength of the forefoot of the right foot.

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5. Fig. 4. Dynamic pedobarography of both feet before surgery: a — left foot, b — right foot. The lateral displacement of the load vector is determined, areas of overload of the outer parts of the foot are determined.

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6. Fig. 5. Preoperative 3-D planning of a customized subtalar implant: a — modeling the required size of bone resection of the calcaneus, b — modeling the congruence of the subtalar joint after installation of a hemiendoprosthesis.

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7. Fig. 6. Intraoperative view of the right foot after implantation of a hemiendoprosthesis of the subtalar joint: the prosthesis is stable, the congruence of the articular surfaces of the hemiendoprosthesis and the talus is determined.

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8. Fig. 7. Appearance of the right foot after 12 months after surgery: a — rear view, b — side view. A moderate valgus position of the heel bone is determined, postoperative scars without signs of inflammation.

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9. Fig. 8. MSCT scans of the right ankle and foot 12 months after surgery: a — frontal projection, b — sagittal projection. No zone of lysis around the hemiendoprosthesis was detected, no signs of degenerative changes in the articular surface of the talus were detected.

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10. Fig. 9. X-ray of the right foot with a load in the lateral projection: A — Böhler angle 20°, B — Gissan angle 118°.

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11. Fig. 10. Dynamic pedobarography 12 months after hemiprosthesis of the subtalar joint: a — left foot, b — right foot. The physiological distribution of the load vector of the right foot is determined without areas of increased pressure.

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12. Fig. 11. Dynamic pedobarography graph after treatment: a — left foot, b — right foot. Equivalent strength of both feet is noted. No signs of increased strength in the midfoot.

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